Rethinking the relabelling of schizophrenia

I think the Japanese may have got it right in the sense that their
conceptualisation embodied in the word may be the most important
concept. Their term means integration or, importantly, social
integration disorder. Their previous term for schizophrenia was very
highly culturally stigmatised. Their culture is still very structured
and hierarchical so deviance from the social order had a much higher
stigma than in other countries.

The two original labels for schizophrenia - dementia praecox and the
"group of schizophrenias" (I think schizogruppen was the word used in
the title of Bleuler's paper in 1908 - were about conceptualisations in
the problems of the individual. The majority of psychiatric research in
the developed world has focused on the psychpatholgy of the individual.
Even today measures of psychopathology that may have little relevance to
the individual's prognosis are still studied and used.

Romme's reconceptualisation - post traumatic psychosis or whatever - is
important because it takes a psychological view of the problem and
considers the environmental factors that caused the psychosis, i.e. the
high level of childhood trauma seen in people who hear voices. This
lends to a more compassionate view than the biomedical model of brain
disorder according to one study. His work and the work of others' in the
progressive mental health field has, in my opinion, been the greatest
force of change in the mainstream treatment of psychosis, hearing voices
and disorders on the schizophrenia spectrum.

It's the consideration of the 'disease' or disability caused by the
condition needs to be addressed with the understanding of the social
model of disability. The International Pilot Study of Schizophrenia
showed better outcomes in developing world countries that didn't have
the expensive, research-driven psychiatric mental healthcare systems of
the developed world. The social model of disablitiy has been
successfully applied to helping people with severe physical disabilities
however it has not been successfully extended to common mental disorders
and mental illnesses.

The Japaneses relabelling and reconceptualisation offers the best hope
for this new aim in treatment. R D Laing has made this point better than
me. It's society and the structures that need to change as a healthcare
objective. The Japanese concept of Togo Shitcho Sho may be the next step
forward in progress.